Drug of No-Choice: A 12-step Perspective

Guest Blog by Shale Marks, LCSW CADC

For many years, the treatment industry has adopted the term “drug of choice” when working with patients diagnosed with substance use disorder. While on the face of it, “drug of choice” may seem like it makes sense from a layperson’s perspective. From a clinical point of view, it is outdated and inconsistent with science. We now know that in a person who struggles with substance use disorder, eating disorders, gambling addiction, self-injury behavior, that what most people call their drug of choice is actually their drug of no-choice. In a person who is afflicted with any of the aforementioned diseases, the prefrontal cortex, the part of the brain responsible for executive function, is compromised and at certain times power, choice and control are unavailable. After all, why would anybody choose to destroy their lives and create distance and separation from the people who love them? The reality is that in a person who suffers from addiction, there is a hijacking of the mind which occurs which prevents normal functioning of executive function. All actions are born from thought, and what the addicted mind produces is not news, it is propaganda.

The absence of choice can be a difficult concept for families and patients to comprehend. They may say to their loved one, “Why don’t you just quit?” or “If you really wanted to, you could stop.” or  “If you really loved us, you would stop.” At times it has been viewed as bad behavior or a moral problem. The disease can be misperceived as an abdication of responsibility. On the contrary, it is quite the opposite. The concession and inner surrender which accompanies the admission of powerlessness that a patient has lost the ability to choose whether or not they will engage with their drug of no-choice is not a ceding of responsibility, it is just the opposite. When faced with the reality of a chronic, progressive, and fatal illness, patients are guided toward recovery. Their disease has a voice, but no longer gets a vote. Patients begin to learn that they are not responsible for their disease, but they are responsible for their recovery.

In a study released by Stanford University in October of 2020, it was found that twelve-step facilitation (TSF) reduced the cost of health care by $10K per individual while pursuing a course of treatment. The same study (with over 10,000 participants) found that TSF was 60% more effective than cognitive based approaches.  While we at SunCloud Health support and use other approaches which support mental health, we view addiction through the twelve-step lens because it works. If it works, then why is there sometimes resistance to using the twelve steps? There are some roadblocks that people encounter along the way that I would consider myths. For example, the myth that people are discouraged from using medication, or that it’s religious program, that members are forced to stay in a position of powerlessness or that they will never be able to trust themselves. Certainly, as in any society, it is made up of individual humans. We encourage patients to look for 12 step groups which encourage unity rather than rigidity. Like the myth that addicts have had the term drug of choice foist upon them for the better part of the past 30 years, many of these myths can be dispelled by reading the basic text of Alcoholics Anonymous, a book which has been adopted by many of the twelve-step programs. As a person in recovery myself, the most valuable piece of information that I was given from the very beginning was, “Don’t let anybody read your literature for you.” 

Watch the entire webinar hosted by Shale Marks, LCSW CADC at SunCloud Health.